﻿<%@ Control Language="C#" AutoEventWireup="true" CodeBehind="ProfilePaymentControl.ascx.cs"
    Inherits="_4T.ASCX.ProfilePaymentControl" %>
<%@ Register Src="UploadZone.ascx" TagName="UploadZone" TagPrefix="uc2" %>
<section class="grid_12">
    <div class="block-border">
        <script type="text/javascript">
            function checkValidate() {
                if (document.getElementById("MainPlaceHolder_ProfilePaymentControl1_txtComment").value == "") {
                    alert("Vui lòng nhập nhận xét");
                    return false;
                }
                if (document.getElementById("MainPlaceHolder_ProfilePaymentControl1_txtCreatedDate").value == "") {
                    alert("Vui lòng nhập thời gian thanh toán");
                    return false;
                }
            }
        </script>
        <form class="block-content form" id="simple_form" method="post" action="" runat="server">
            <h1>Thanh toán hồ sơ</h1>
            <dl class="accordion">
                <h1>Phê duyệt hồ sơ</h1>
                <dl class="accordion">
                    <dt><span class="number">1</span> Thông tin bệnh nhân</dt>
                    <dd>
                        <fieldset>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">
                                        Họ tên:
                                    </label>
                                </div>
                                <div class="rp_right">
                                    <asp:Label ID="lbPatientName" class="full-width" runat="server"></asp:Label>
                                </div>
                            </div>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">
                                        Ngày sinh:
                                    </label>
                                </div>
                                <div class="rp_right">
                                    <asp:Label ID="lbDOB" class="full-width" runat="server"></asp:Label>
                                </div>
                            </div>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">
                                        Giới tính:
                                    </label>
                                </div>
                                <div class="rp_right">
                                    <asp:DropDownList ID="ddlGender" runat="server" Enabled="False">
                                        <asp:ListItem Value="Male" Text="Nam"></asp:ListItem>
                                        <asp:ListItem Value="Female" Text="Nữ"></asp:ListItem>
                                    </asp:DropDownList>
                                </div>
                            </div>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">
                                        CMND:
                                    </label>
                                </div>
                                <div class="rp_right">
                                    <asp:Label ID="lbIDNumber" class="full-width" runat="server"></asp:Label>
                                </div>
                            </div>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">Địa chỉ thường trú: </label>
                                </div>
                                <div class="rp_right">
                                    <asp:Label ID="lbPermAddr" class="full-width" runat="server"></asp:Label>
                                </div>
                            </div>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">Địa chỉ tạm trú: </label>
                                </div>
                                <div class="rp_right">
                                    <asp:Label ID="lbTempAddr" class="full-width" runat="server"></asp:Label>
                                </div>
                            </div>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">Số điện thoại di động: </label>
                                </div>
                                <div class="rp_right">
                                    <asp:Label ID="lblMobileNumber" class="full-width" runat="server"></asp:Label>
                                </div>
                            </div>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">Số điện thoại cố định: </label>
                                </div>
                                <div class="rp_right">
                                    <asp:Label ID="lbPhoneNumber" class="full-width" runat="server"></asp:Label>
                                </div>
                            </div>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">Người đại diện liên hệ khi khẩn cấp: </label>
                                </div>
                                <div class="rp_right">
                                    <asp:Label ID="lbRepresentativeName" class="full-width" runat="server"></asp:Label>
                                </div>
                            </div>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">Số điện thoại: </label>
                                </div>
                                <div class="rp_right">
                                    <asp:Label ID="lbRepresentativePhone" class="full-width" runat="server"></asp:Label>
                                </div>
                            </div>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">Đầu mối liên hệ ở địa phương. Tên: </label>
                                </div>
                                <div class="rp_right">
                                    <asp:Label ID="lbLocalContactName" class="full-width" runat="server"></asp:Label>
                                </div>
                            </div>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">Số điện thoại: </label>
                                </div>
                                <div class="rp_right">
                                    <asp:Label ID="lbLocalContactPhone" class="full-width" runat="server"></asp:Label>
                                </div>
                            </div>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">Cán bộ y tế: </label>
                                </div>
                                <div class="rp_right">
                                    <asp:Label ID="lbMedicalStaff" class="full-width" runat="server"></asp:Label>
                                </div>
                            </div>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">Số điện thoại: </label>
                                </div>
                                <div class="rp_right">
                                    <asp:Label ID="lbMedicalStaffPhone" class="full-width" runat="server"></asp:Label>
                                </div>
                            </div>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">Cơ sở y tế đang điều trị: </label>
                                </div>
                                <div class="rp_right">
                                    <asp:Label ID="lbMedicalFacility" class="full-width" runat="server"></asp:Label>
                                </div>
                            </div>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">Ghi chú khác: </label>
                                </div>
                                <div class="rp_right">
                                    <asp:Label ID="lbNote" class="full-width" runat="server"></asp:Label>
                                </div>
                            </div>
                        </fieldset>
                    </dd>
                    <dt><span class="number">2</span> Tóm tắt bệnh án</dt>
                    <dd>
                        <fieldset>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">
                                        Chuẩn đoán
                                    </label>
                                </div>
                                <div class="rp_right">
                                    <asp:Label ID="lblDiagnosis" class="full-width" runat="server"></asp:Label>
                                </div>
                            </div>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">
                                        Thời gian mắc bệnh:
                                    </label>
                                </div>
                                <div class="rp_right">
                                    <asp:Label ID="lbMedicalTime" class="full-width" runat="server"></asp:Label>
                                </div>
                            </div>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">
                                        Phương pháp cần chữa trị:
                                    </label>
                                </div>
                                <div class="rp_right">
                                    <asp:Label ID="lbTreatmentMethod" class="full-width" runat="server"></asp:Label>
                                </div>
                            </div>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">
                                        Hoàn cảnh, khó khăn đang gặp phải:
                                    </label>
                                </div>
                                <div class="rp_right">
                                    <asp:Label ID="lbSituation" class="full-width" runat="server"></asp:Label>
                                </div>
                            </div>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">Cần giúp đỡ: </label>
                                </div>
                                <div class="rp_right">
                                    <asp:Label ID="lbSupport" class="full-width" runat="server"></asp:Label>
                                </div>
                            </div>
                        </fieldset>
                    </dd>
                    <dt><span class="number">3</span> Người cung cấp thông tin</dt>
                    <dd>
                        <fieldset>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">
                                        Họ tên:
                                    </label>
                                </div>
                                <div class="rp_right">
                                    <asp:Label ID="lbInfoSupplierName" runat="server"></asp:Label>
                                </div>
                            </div>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">
                                        Số điện thoại:
                                    </label>
                                </div>
                                <div class="rp_right">
                                    <asp:Label ID="lbInfoSupplierPhone" runat="server"></asp:Label>
                                </div>
                            </div>
                            <div class="rpContain">
                                <div class="rp_left">
                                    <label for="complex-title">
                                        Email: 
                                    </label>
                                </div>
                                <div class="rp_right">
                                    <asp:Label ID="lbEmail" runat="server"></asp:Label>
                                </div>
                            </div>
                        </fieldset>
                    </dd>
                </dl>

                <fieldset class="grey-bg required">
                    <legend>Xác nhận từ bệnh viện</legend>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label>Đang bị bệnh gì ? </label>
                        </div>
                        <%--<div class="rp_right"><input type="text" name="simple-required" id="simple-required" value="" class="full-width"></div>--%>
                        <div class="rp_right">
                            <asp:TextBox CssClass="full-width" ID="txtDiseaseName" runat="server" Enabled="False"></asp:TextBox>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label>Bệnh đang ở giai đoạn nào ? </label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox CssClass="full-width" ID="txtPhaseOfDisease" runat="server" Enabled="False"></asp:TextBox>
                        </div>

                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label>Có khả năng chữa trị không? </label>
                        </div>
                        <div class="rp_right">
                            <p class="input-height grey-bg">
                                <%--													    <input type="radio" name="complex-en-active" id="complex-en-active-1" value="1" checked="checked">&nbsp;<label for="complex-en-active-1">Yes</label> 
													    <input type="radio" name="complex-en-active" id="complex-en-active-0" value="0">&nbsp;<label for="complex-en-active-0">No</label>--%>

                                <asp:RadioButton ID="rdoIsTreatYes" runat="server" GroupName="gpTreat" Enabled="False" />&nbsp;<label for="complex-en-active-1">Yes</label>
                                <asp:RadioButton ID="rdoIsTreatNo" runat="server" GroupName="gpTreat" Enabled="False" />&nbsp;<label for="complex-en-active-1">No</label>
                            </p>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label>Có khả năng phục hồi sau khi điều trị không? </label>
                        </div>
                        <div class="rp_right">
                            <p class="input-height grey-bg">
                                <asp:RadioButton ID="rdoIsRecoverYes" runat="server" GroupName="gpRecover" Enabled="False" />&nbsp;<label for="complex-en-active-1">Yes</label>
                                <asp:RadioButton ID="rdoIsRecoverNo" runat="server" GroupName="gpRecover" Enabled="False" />&nbsp;<label for="complex-en-active-1">No</label>
                            </p>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label>Chi phí dự kiến: </label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox CssClass="full-width" ID="txtAnticipateSpend"
                                runat="server" Enabled="False"></asp:TextBox>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label>Thời gian điều trị: </label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox CssClass="full-width datepicker" ID="txtTreatTime"
                                runat="server" Enabled="False"></asp:TextBox>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label>Nhận xét của  bác sĩ: </label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox CssClass="full-width" ID="txtCommentOfDoctor" runat="server" TextMode="MultiLine" Enabled="False"></asp:TextBox>
                        </div>
                    </div>
                </fieldset>

                <fieldset class="grey-bg required">
                    <legend>Xác nhận từ địa phương</legend>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label>Có thuộc diện diện nghèo, hoàn cảnh khó khăn không?</label>
                        </div>
                        <div class="rp_right">
                            <p class="input-height grey-bg">
                                <asp:RadioButton ID="rdoIsPoorYes" runat="server" GroupName="gpPoor" Enabled="False" />&nbsp;<label for="complex-en-active-1">Yes</label>
                                <asp:RadioButton ID="rdoIsPoorNo" runat="server" GroupName="gpPoor" Enabled="False" />&nbsp;<label for="complex-en-active-1">No</label>
                            </p>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label>Có phải là lao động chính trong gia đình không?</label>
                        </div>
                        <div class="rp_right">
                            <p class="input-height grey-bg">
                                <asp:RadioButton ID="rdoIsDirectLabourYes" runat="server" GroupName="gpDirectLabour" Enabled="False" />&nbsp;<label for="complex-en-active-1">Yes</label>
                                <asp:RadioButton ID="rdoIsDirectLabourNo" runat="server" GroupName="gpDirectLabour" Enabled="False" />&nbsp;<label for="complex-en-active-1">No</label>
                            </p>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label>Nguyên nhân lâm bệnh?</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox CssClass="full-width" ID="txtCauseIll" runat="server" Enabled="false" TextMode="MultiLine"></asp:TextBox>
                        </div>
                    </div>
                </fieldset>


            </dl>

            <fieldset class="grey-bg required">
                <legend>Đánh giá của người thanh toán</legend>
                <%--<div class="rpContain">
						<div class="rp_left"><label for="complex-title">Đánh giá:</label></div>
						<div class="rp_right">
												<p class="input-height grey-bg">
													<asp:RadioButton ID="rdoCheck" runat="server" GroupName="gpDecide" />&nbsp;<label for="complex-en-active-1">Hồ sơ được xác nhận</label>
												</p>
                                                <p class="input-height grey-bg">
                                                    <asp:RadioButton ID="rdoNotCheck" runat="server" GroupName="gpDecide" />&nbsp;<label for="complex-en-active-1">Hồ sơ không được xác nhận</label>
                                                </p>
                                                <p class="input-height grey-bg">
                                                    <asp:RadioButton ID="rdoNeedInfo" runat="server" GroupName="gpDecide" />&nbsp;<label for="complex-en-active-1">Hồ sơ cần thêm thông tin</label>
                                                </p>
                        </div>
                    </div>--%>
                <div class="rpContain">
                    <div class="rp_left">
                        <label for="complex-title" class="required">Nhận xét: </label>
                    </div>
                    <div class="rp_right">
                        <asp:TextBox CssClass="full-width" ID="txtComment" runat="server" TextMode="MultiLine"></asp:TextBox>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title" class="required">Thời gian thanh toán:</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtCreatedDate" runat="server" CssClass="full-width datepicker"></asp:TextBox>
                        </div>
                    </div>
                </div>
            </fieldset>

            <fieldset class="grey-bg">
                <legend>Hình ảnh, video đính kèm</legend>
                <div class="rpContain">
                    <uc2:UploadZone ID="UploadZone1" runat="server" />
                </div>
            </fieldset>

            <fieldset class="grey-bg no-margin" style="text-align: center;">
                <p class="input-with-button">
                    <asp:Button ID="btnAdd" runat="server" OnClick="btnAdd_Click" Text="Save" CssClass="big-button" OnClientClick="return checkValidate()" />
                    <asp:Button ID="btnClear" runat="server" Text="Clear" CssClass="big-button" />
                </p>
            </fieldset>
        </form>
    </div>
</section>
